Download Preventing Medication Errors

Chapter 9
MAT 119
Medication Errors
 Medication errors are a significant problem in health
care.
 Mistakes can occur at various points in each phase of
the medication administration process: prescription,
transcription, and administration.
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Medication Errors
 A medication error is any preventable event that
may cause or lead to inappropriate medication
use or harm to a patient.
 Since 2000, the Food and Drug Administration
(FDA) has received more than 95,000 reports of
medication errors.
 Reports are voluntary.
http://www.fda.gov/Drugs/DrugSafety/MedicationErrors/default.htm
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Medication Errors
 Effects of medication errors
 Increase length of stay
 Increased cost
 Patient disability
 Death
 Nurse’s personal and professional status, confidence,
and practice
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Safe Medication Administration
 Medication orders are either written or
verbal, and must contain all seven parts
1. patient’s name
2. date and time of the order
3. drug name
4. dosage/amount
5. route
6. frequency
7. prescriber’s name and licensure
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Safe Medication Administration
 Prescription
 Licensed providers must have authority within their
state to write prescriptions
 Includes telephone/verbal orders


Telephone orders: Write it down, read it back, get
confirmation
Verbal orders: Repeat and verify all verbal orders for accuracy
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Safe Medication Administration
 Nurses play an important role in preventing errors
 Practitioner who administers a drug shares liability for
injury, even if medical order was incorrect
 Verify safety of drug order by checking a reliable drug
reference
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Institute for
Safe Medication Practice (ISMP)
 Identifies unsafe
 Abbreviations
 Acronyms
 Symbols
 Error Prone Abbreviations
http://www.ismp.org/Tools/errorpron
eabbreviations.pdf

(also on pp 182-183)
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“Do Not Use” List
 Joint Commission has an official “Do Not Use” list of
medical abbreviations
 Official Do Not Use list
http://www.jointcommission.org/assets/1/18/Do_Not_
Use_List.pdf
 (also on p 181)
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Do Not Use
 “U” (unit)
 IU (international unit)
 Q.D, QD, q.d., qd (daily)
 Q.O.D, QOD, q.o.d., qod (every other day)
 SC (subcut, or subcutaneously)
 Trailing zero (X.0 mg)
 Lack of leading zero (.X mg)
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Safe Medication Administration
 Six Rights of Safe Medication Administration
1. Right patient
2. Right drug
3. Right dosage
4. Right route
5. Right frequency/time
6. Right documentation
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1. Right Patient
 Correctly identify patient prior to medication
administration; of the three most common causes of
medication errors, failure to accurately identify a
patient is the most common
 Joint Commission requires two (2) unique patient
identifiers – neither can be the patient’s room number
 Compare armband with medication administration
record
 Ask the patient to state his name and date of birth or
name and ID on arm band
 Compare picture to patient
 Technological advances to prevent errors
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Right Patient
 Tell patient at time of administration what medication
and dosage is being administered – patient has Right
to Know!
 Patient may question drug or dosage
 Provides an opportunity for medication teaching
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2. Right Drug
 Check medication 3 times to ensure the right drug by
checking the medication label against the order or
MAR during the administration process:
 On first contact with drug
 Prior to measuring

Pouring, counting, or withdrawing
 After obtaining the drug, just prior to administration
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Right Drug
 Be aware of distractions
 Do not multitask during drug administration
 Use bar-coding scanning when available
 Be knowledgeable about the drug’s actions,
indications, and contraindications
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3. Right Route
 Consult a drug information source to confirm
correct route
 May need to change or clarify forms or routes of
the drug for safe medication administration
 NPO status
 Nasogastric or surgically inserted tubes
 Time-released or enteric-coated medications
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4. Right Frequency / Time
 Order should include frequency of administration
 Use safe abbreviations
 Joint Commission has identified q.d. as being
transcribed as q.i.d.
 Q.D. needs to be written as daily
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5. Right Dose
 Illegible prescriber’s handwriting, a transcription error,
miscalculation of the amount, or misreading the label
can result in errors of an incorrect dose of medication
 Carefully read and clarify drug orders
 Recheck labels
 Have two nurses double-check potent medications
 Common sources of errors

Insulin
 Consult drug references
 Accurate dosage calculations – main purpose of course!!
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6. Right Documentation!
 The nurse MUST document administration of the drug
 If it’s not documented… it wasn’t done!
 Document AFTER administration of medication
 NEVER leave meds at patient’s bedside
 With computerized delivery system, a second scan is
done as a signature
 Omitting documentation can result in over or under
medication
 PRN medications is most problematic in over
medication
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Computerized Systems
 CPOE – computerized physician order entry
 Avoids illegible writing
 All patients admitted to the facility receive a barcoded
armband
 The eMAR and barcoding system uses mobile carts
with laptops, tethered barcode scanners, or desktop
computers with wireless scanners to read barcode
labels on medications and patient armbands
 Automated Dispensing Machines
 These do NOT prevent medication errors!!!
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eMar
 The nurse views the eMAR screen and reviews the
patient's medication list and verifies with the
physician orders.
 eMAR alerts the nurse about the next dose due,
overdue doses, or cautions about medications
 Nurse takes the cart to the patient, scans the
medication and the patient's wristband.
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Reminders
 Check labels carefully
 Follow Six Rights of medication administration
 Be aware and adhere to facility’s policies on
medication administration
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Reminders
 Check medication three times before administering
 Identify if the form is appropriate for the route
 If unsure of order, clarify prior to administration
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Reminders
 When you give a medication, you are responsible if an
injury occurs even if the order was incorrect.
 When you receive an order, make sure it is safe.
 If you are not familiar with the medication, look it up
in a reliable reference such as a Nurse’s Drug
Handbook, Hospital Formulary, hospital pharmacy
intranet
 YOU are the last line of defense between a safe or not
safe medication administration.
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